Postoperative ACTH-stimulated aldosterone predicts biochemical outcome in primary aldosteronism

Author:

Bruedgam Denise1ORCID,Adolf Christian1ORCID,Schneider Holger1ORCID,Schwarzlmueller Paul1,Mueller Lisa1,Handgriff Laura1,Bidlingmaier Martin1ORCID,Kunz Sonja1,Zimmermann Petra2,Deniz Sinan3,Williams Tracy Ann1,Beuschlein Felix14ORCID,Reincke Martin1ORCID,Heinrich Daniel A15ORCID

Affiliation:

1. Medizinische Klinik und Poliklinik IV, LMU Klinikum , 80336 München , Germany

2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, LMU Klinikum , 80336 München , Germany

3. Klinik und Poliklinik für Radiologie, LMU Klinikum , 80336 München , Germany

4. Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich (USZ) und Universität Zürich (UZH) , Raemistrasse 100 , CH-8091 Zürich, Switzerland

5. Hormon- und Stoffwechselzentrum München , Residenzstr. 3 , 80333 München, Germany

Abstract

Abstract Objective Primary aldosteronism (PA) is the most common surgically curable cause of hypertension. Unilateral aldosterone-producing adenoma can be treated with adrenalectomy. Clinical and biochemical outcomes are assessed 6-12 months after adrenalectomy according to primary aldosteronism surgical outcome (PASO) consensus criteria. Earlier prediction of biochemical remission would be desirable as it could reduce cumbersome follow-up visits. We hypothesized that postoperative adrenocorticotropic hormone (ACTH) stimulated plasma aldosterone concentrations (PAC) measured shortly after adrenalectomy can predict PASO outcomes. Design Retrospective cohort study. Methods We analyzed 100 patients of the German Conn's registry who underwent adrenalectomy and postoperative ACTH stimulation tests within the first week after adrenalectomy. Six to twelve months after adrenalectomy we assessed clinical and biochemical outcomes according to PASO criteria. Serum cortisol and PAC were measured by immunoassay at baseline and 30 min after the intravenous ACTH infusion. We used receiver operating characteristics (ROC) curve analysis and matched the parameters to PASO outcomes. Results Eighty-one percent of patients had complete, 13% partial, and 6% absent biochemical remission. Complete clinical remission was observed in 28%. For a cut-off of 58.5 pg/mL, stimulated PAC could predict partial/absent biochemical remission with a high sensitivity (95%) and reasonable specificity (74%). Stimulated PAC's area under the curve (AUC) (0.89; confidence interval (CI) 0.82-0.96) was significantly higher than other investigated parameters. Conclusions Low postoperative ACTH stimulated PAC was predictive of biochemical remission. If confirmed, this approach could reduce follow-up visits to assess biochemical outcome.

Funder

Else Kröner-Fresenius-Stiftung

German Conn's

Registry‒Else Kröner Hyperaldosteronism Registry

European Research Council under the European Union's

Horizon 2020 research and innovation programme

Clinical Research Priority Program of the University of Zurich for the CRPP HYRENE

Förderung für Forschung und Lehre

LMU University Hospital Munich

German Research Foundation

DFG Clinician Scientist Program In Vascular Medicine

Publisher

Oxford University Press (OUP)

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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1. Nanotechnology-based Detection Strategies for Hypertension Biomarkers;Chemical Research in Chinese Universities;2024-05-15

2. The Spectrum of Dysregulated Aldosterone Production: An International Human Physiology Study;The Journal of Clinical Endocrinology & Metabolism;2024-03-07

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